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Verma A, Kar AG, Meena RN, Patne SCU, Mishra SP, Khanna S, Khanna R. Evaluation of Estrogen Receptor, Progesterone Receptor, and Human Epidermal Growth Factor Receptor 2 Status Before and After Neoadjuvant Chemotherapy in Breast Cancer Patients. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02380-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Tahir M, Alexander S, Tariq R, Wysham K, Andrews J, Aly H, Khanna S, Singh N. POS0537 TRENDS AND PREDICTORS OF INPATIENT MORTALITY IN PATIENTS WITH CLOSTRIDIODES DIFFICILE INFECTION AMONG THOSE WITH AND WITHOUT RHEUMATOID ARTHRITIS: A NATIONWIDE ANALYSIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:People with rheumatoid arthritis (RA) have a higher risk of serious infections. The most common nosocomial infection in the United States (US) is Clostridioides difficile infection (CDI) and yet, little is known regarding the impact of comorbid RA on outcomes in persons hospitalized with CDI.Objectives:To evaluate the trends over time and predictors of inpatient mortality in hospitalized patients with CDI comparing those with and without RA.Methods:We used the National Inpatient Sample (NIS) database, the largest available all-payer database of inpatient hospitalizations in the US. Patients aged ≥18 years admitted with CDI from 2006-2018 were included. Patients with RA were identified using the International Classification of Diseases (ICD) 9 and 10 codes. Categorical variables between CDI patients with and without RA were compared using Chi-squared test. Temporal trends of hospitalization charges, length of stay (LOS) and inpatient mortality were assessed using the Cochrane Armitage test. Predictors of inpatient mortality were assessed using multivariable logistic regression adjusting for: age ≥65, sex, race, presence of RA, and Elixhauser comorbidity index.Results:There were 4,396,945 hospitalizations with a discharge diagnosis of CDI in the study period, of which 111,336 (2.5%) had a coexisting diagnosis of RA. Over the study period, the proportion of CDI patients with a diagnosis of RA increased from 1.7% in 2006 to 3.3% in 2018 with a statistically significant trend of rise (p trend<0.001). There were significantly more females in the RA group (78.2%) than without RA (57.5%), p <0.001. RA group was significantly younger (68.0 vs 70.7, P<0.001). Races were similar between the groups.The inflation-adjusted average charge for hospitalization for CDI without RA was significantly higher than for CDI with RA ($95,863 vs $73,025, p<0.001). There was an increasing trend in inflation-adjusted average charge for hospitalization for both CDI without RA ($76,966 in 2006 to $104,552 in 2018, p<0.001) and CDI with RA ($55,689 in 2006 to $77,295 in 2018, p<0.001). Patients with or without RA had the same median length of stay (LOS) of 7 days. But when trended over time, for patients without RA, the median LOS decreased from 8 days in 2006-08 to 6 days in 2016-18 whereas for patients with RA, the median LOS fluctuated between 6 and 7 days over the course of study period.CDI patients without RA had a significantly higher mortality over the study period than those with RA (7.8% vs 6.1%, p<0.001). Among non-RA CDI patients, mortality decreased from 9.3% in 2006 to 6.3% in 2018 (p trend <0.001). Hospitalizations of people with CDI and comorbid RA showed an overall decreasing trend (p trend <0.001).The multivariable analyses found age≥65 was associated with increased inpatient mortality (adjusted odds ratio [aOR], 1.77, 95% confidence interval [CI], 1.73-1.80), whereas a diagnosis of RA was associated with a decreased mortality (aOR 0.86, 95% CI, 0.81-0.91) (Table 1).Table 1.Predictors of inpatient mortalityaOR95% C.I. for aORP-valueLowerUpperAge ≥ 651.7651.7301.801<0.001Hospitalization years -Years 2006-2011Ref -Years 2011-20140.7070.6930.721<0.001 -Years 2015-20180.5820.5690.594<0.001Elixhauser Comorbidity Index1.0561.0551.056<0.001Rheumatoid Arthritis0.8590.8100.911<0.001Female0.8700.8550.885<0.001Race -WhiteRef -African American1.0711.0441.099<0.001 -Hispanic1.1441.1081.180<0.001 -Asian/Pacific Islander1.2671.2001.337<0.001 -Native American1.0220.9101.1470.716 -Other races1.2631.2011.329<0.001aOR = Adjusted Odds Ratio; C.I.= confidence intervalConclusion:In this nationwide study, among hospitalized patients with CDI, those with comorbid RA had significantly decreased odds of inpatient mortality than those without RA. Further studies are needed to understand this association.Figure 1.Disclosure of Interests:None declared
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Mansur A, Chandler J, Khanna S, Vinson M, Nguyen A. POS-814 INTRADIALYTIC RELATIVE BLOOD VOLUME MONITORING IN HEART FAILURE PATIENTS: RETROSPECTIVE DATA ANALYSIS. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Bhat A, Chen H, Khanna S, Mahajan V, Gupta A, Burdusel C, Wolfe N, Lee L, Gan G, Dobbins T, MacIntyre C, Tan T. Diagnostic and Prognostic Value of Novel Echocardiographic Biomarkers in Identification of Cardioembolism and Prediction of Outcomes in Patients with Stroke of Undetermined Source. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Khanna S, Newman J, Gupta A, Wen I, Bhat A, Chen H, Gan G, Tan T. Left Ventricular Global Longitudinal Strain is a Predictor of Adverse Cardiovascular Outcomes in Patients With Rheumatoid Arthritis. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wen I, Khanna S, Thakur A, Chen H, Bhat A, Gan G, Tan T. Patients With Neuro-Immunological Disorders With Normal Left Ventricular Ejection Fraction Demonstrate Impaired Left Ventricular Global Longitudinal Strain. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Khanna S, Amarasekera A, Li C, Bhat A, Chen H, Gan G, Tan T. Characterisation of Myocardial Structure and Function by Cardiac Magnetic Resonance Imaging in Adult Patients With Acute-Phase Myocarditis: A Systematic Review and Meta-analysis. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Khanna S, Herzog J, Gebhardt R. Influence of enzymatic cross‐linking and pH values on the internal structure of casein micelles and from them manufactured functional materials. CHEM-ING-TECH 2020. [DOI: 10.1002/cite.202055206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Srivastava V, Jha PK, Samhitha CV, Khanna S. Unusual Presentation of Benign Breast Disease in an Adolescent Girl. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02548-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Khanna S, Tan J, Chen H, Bhat A, Gan G, Tan T. 372 Left Ventricular Sphericity Index is a Predictor of Cardiovascular Events in Patients With Anterior Transmural Myocardial Infarction but not in Takotsubo Syndrome. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kodsi M, Gupta A, Drescher A, Oh F, Chen H, Bhat A, Kanthan A, Tan T, Khanna S. 384 Pacing Burden and Right Ventricular Function. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Khanna S, Bhat A, Malaty M, Kim S, Talisayon R, Ravindran J, Garikapati K, Tsihlis G, Tan T, Burgess D. 742 Non-Traditional Predictors of Adverse Cardiovascular Outcomes Following Acute Coronary Syndromes Post-Percutaneous Coronary Intervention. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Tan J, Tan S, Mok C, Shehab S, Chen H, Bhat A, Gan G, Tan T, Khanna S. 500 Impact of Left Ventricular Hypertrophy Phenotypes on Electrocardiographic Detection of Left Ventricular Hypertrophy. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chen H, Khanna S, Kayes T, Bhat A, Gan G, Ahlenstiel G, Tan T. 300 Characterisation of Atrial and Ventricular Myocardial Deformation Indices with Increasing Body Mass Index. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Khanna S, Newman J, Bhat A, Chen H, Fernandez F, Gan G, Tan T. 385 Patients with Systemic Lupus Erythematosus With Normal Left Ventricular Ejection Fraction Demonstrate Impaired Left Ventricular Global Longitudinal Strain. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Khanna S. Clostridial vaccines in the pipeline. DRUG FUTURE 2020. [DOI: 10.1358/dof.2020.45.9.3168446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Makarious D, Bhat A, Khanna S, Chen H, Drescher A, Stephens M, Fernandez F, Gan G, Tan T. 312 Correlation between Atrial Fibrillation Burden and Changes in Indices of Left Atrial Size and Function. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Von Itzstein M, Gupta A, Mara K, Khanna S, Gerber D. P1.16-01 Complications Associated with Lung Biopsies in Patients with Lung Cancer: A Population Based Analysis. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bhat A, Chen HHL, Khanna S, Gan CH, Menzies R, Nunes CM, MacIntyre R, Tan TC. P2468Clinical and cardiac structural differences between paroxysmal and persistent/permanent non-valvular atrial fibrillation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Atrial Fibrillation (AF) is a heterogeneous condition and is traditionally classified by duration (paroxysmal, persistent and permanent). There is a relationship between AF and left atrial (LA) remodeling, with increased likelihood of AF recurrence and maintenance with increasing LA volumes.
Purpose
To assess clinical and cardiac structural differences between the subtypes of AF.
Methods
We examined 1247 (68±13.4y; 50% men) consecutive admissions presenting to our institution with the primary diagnosis of AF. Repeat admissions (n=263) were excluded. Of remaining 984 subjects, a majority had diagnosed paroxysmal (72.2%), with lower numbers of persistent (23.4%) and permanent (4.4%) AF. Echo parameters of cardiac chamber size and function were examined in a subset of subjects with complete echo (n=646) performed during incident hospital admission.
Results
There were significantly higher rates of diabetes mellitus (p=0.03), ischaemic heart disease (IHD; p=0.04) and peripheral vascular disease (PVD; p=0.02) in those with persistent/permanent AF compared to paroxysmal AF. No significant differences in age (p=0.19), BMI (p=0.42), OSA (p=0.05), or hypertension (p=0.76) was noted. There were significant differences in left ventricular (LV) mass and systolic function, LA size and function between the two groups (Table 1). Receiver operator curve analysis revealed that LAEF was a discriminator for persistent/permanent AF with an area under the curve of 0.689 (95% CI, 0.646 to 0.732; p<0.001).
Echo parameters in AF subtype Echocardiographic Parameters Paroxysmal AF (n=433) Persistent and Permanent AF (n=213) Significance (p value) LVEDD (cm) 4.8±3.0 5.0±0.9 0.29 LVESD (cm) 3.3±1.3 3.7±1.1 <0.01 IVS thickness (cm) 1.2±0.7 1.1±0.3 0.44 PW thickness (cm) 1.1±0.7 1.1±0.2 0.77 LV mass (g) 92.3±28.3 108.2±35.3 <0.01 LVEF (%) 56.1±14.1 47.4±16.8 <0.01 LA Expansion Index 89.4±69.1 53.4±40.3 <0.01 Min LA Volume indexed (ml/m2) 18.9±17.2 27.3±20.6 0.01 Max LA Volume indexed (ml/m2) 32.5±19.2 37.7±15.3 <0.01 LAEF (%) 41.8±16.4 31.5±13.6 <0.01
Conclusions
Our results suggest diabetes, IHD and PVD are associated with persistent/permanent AF. Additionally, greater LA remodeling and reduced atrial function was noted in this group, suggestive of an association between duration of AF electrical burden and LA remodeling and function.
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Khanna S, Newman JM, Gan G, Bhat A, Chen H, Tan T. P4353Global longitudinal strain is a measure of subclinical left ventricular dysfunction in chronic inflammatory autoimmune conditions. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Myocardial deformation indices are proposed to be a more sensitive marker of subclinical dysfunction compared to standard measures of left ventricular (LV) systolic function. We hypothesize that subclinical myocardial dysfunction is present in chronic inflammatory autoimmune diseases such as Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA), despite both conditions being mediated by different pro-inflammatory modulators.
Purpose
Identify subclinical myocardial dysfunction through assessment of global longitudinal strain in two different chronic autoimmune conditions, SLE and RA.
Methods
Consecutive patients admitted to our institution with known history of SLE or RA (>1 year disease activity) were examined. Patients with preexisting cardiac disease, LVEF <50% and those without comprehensive transthoracic echocardiograms (TTE) were excluded. Mean longitudinal LV strain was performed offline using vendor-independent software (TomTec v4.6) and compared to age- and gender-matched controls with normal LV function and no history of cardiac disease.
Results
Of the 86 patients examined (mean age 53.01±21.74, 85.4% female), 51 (59.3%) had SLE and 35 (40.7%) had RA. No significant difference in BMI, hypertension, hypercholesterolemia, diabetes, obesity, obstructive sleep apnea and stroke was observed between controls and patients with SLE or RA. While there was no significant difference in LVEF between RA patients and matched controls, there was a significantly lower GLS in the RA cohort. Conversely, patients with SLE had significantly lower LVEF and GLS when compared to matched controls, despite LVEF being in the normal range. See Table 1. Receiver operator curve analysis revealed that mean GLS is a better discriminator for autoimmune disease with an area under the curve of 0.829 (95% CI, 0.77 to 0.89; p<0.01) compared to LVEF with an area under the curve of 0.632 (95% CI, 0.55 to 0.72; p<0.01).
Echocardiographic Parameters SLE (n=51) Controls (n=51) Sig (p value) RA (n=35) Controls (n=35) Sig (p value) LVEDV (mls) 102±30 85±20 <0.01 84±28 89±30 0.43 LVESV (mls) 36±17 29±9 0.02 26±14 30±12 0.24 Biplane LVEF % 59±6 63±4 <0.01 62±6 62±5 0.81 LV Mass (grams/m2) 96±34 72±20 <0.01 79±26 82±23 0.67 LV Mean GLS % 16.7±2.8 21.3±2 <0.01 17.8±1.7 19.1±2.5 0.02
Conclusions
Our results suggest that chronic inflammatory conditions (SLE and RA) are associated with subclinical cardiac dysfunction. Impaired GLS may reflect early myocardial damage and be used as a tool for screening of patients with inflammatory conditions.
Acknowledgement/Funding
None
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Saha S, Tariq R, Tosh PK, Pardi DS, Khanna S. Faecal microbiota transplantation for eradicating carriage of multidrug-resistant organisms: a systematic review. Clin Microbiol Infect 2019; 25:958-963. [PMID: 30986562 DOI: 10.1016/j.cmi.2019.04.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 03/21/2019] [Accepted: 04/05/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Multidrug-resistant (MDR) microorganism development in the gut is frequently the result of inappropriate antibiotic use. Faecal microbiota transplantation (FMT) restores normal gut microbiota in patients with Clostridium difficile infection. We hypothesized that it may help in decolonizing MDR organisms (MDROs) and in preventing recurrent MDR infections. OBJECTIVES To assess FMT efficacy (eradication rate) for decolonizing MDROs and preventing recurrent MDR infections. DATA SOURCES Medline, Embase and Web of Science (inception through 11 February 2019). STUDY ELIGIBILITY CRITERIA Clinical trials, retrospective studies, case reports and case series. PARTICIPANTS Patients with MDR infections or MDRO colonization treated with FMT. INTERVENTIONS FMT. METHODS Systematic review. RESULTS Twenty-one studies (one randomized clinical trial, seven uncontrolled clinical trials, two retrospective cohort studies, two case series, nine case reports) assessing 192 patients were included. Three studies assessed FMT efficacy in preventing MDR infections; 16 assessed its effect on MDRO colonization; two assessed both. Data from 151 patients were included in the final analyses. In studies with low to moderate risk of bias, the eradication rate was 37.5% to 87.5%. Efficacy was similar in studies looking at infection or colonization and did not differ by length of follow-up. No serious adverse events from FMT were reported. Seven patients died of other causes. CONCLUSIONS FMT could be used as a treatment for eradicating MDR colonization and possibly preventing recurrent MDR infections, once more supporting efficacy and safety data are available. Larger well-designed randomized controlled trials are needed to further explore this therapy.
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Khanna S, Gan G, Gupta K, Khan W, Bhat A, Chen H, Tan T. Characterisation of Right Ventricular Size and Systolic Function in a Cohort of Myocarditis Patients with Normal LVEF. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Khanna S, Gan G, Gupta K, Khan W, Tan W, Chen H, Bhat A, Tan T. Characterisation of Left Ventricular Shape Change as Defined by Sphericity Index in Patients with Acute Phase Takotsubo Cardiomyopathy and Anterior STEMI Patients. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ravindran J, Talisayon R, Bhat A, Khanna S, Garikapati K, Chen H, Tsihlis G, Latumahina A, Hall G, Gan G, Changsiri B, Burgess D. Acute Coronary Syndromes (ACS) in Western Sydney: 1-year follow-up of ACS patients at Blacktown Hospital. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Khanna S. Ridinilazole. Antibacterial drug, Treatment of Clostridioides difficile infection. DRUG FUTURE 2019. [DOI: 10.1358/dof.2019.44.5.2978058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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